Aims • To introduce the ‘Food, Fun and Active Play for Tiny Tots’ Resources to early years and childcare settings across Wales

Objectives • Demonstrate an understanding of the health issues relating to the early years setting in Wales • List the key public health messages for food and physical activity for 1-3 yr old children • Describe a variety of settings /situations in which the toolkit could be used effectively in the community

Objectives con’t • Discuss some of the skills required to engage parents/carers on the topic of lifestyle change • Describe ways in which the toolkit can link to other local early years health supporting initiatives/programmes

Nutritional issues in young children • Diets of children under 5 in the UK are generally: • Too low in Vitamin A • Too low in Vitamin C • Too low in iron and zinc • Too much added sugar • Too much salt • Some children have low levels of Vitamin D, which can be linked to poor bone health [Ref: Gregory et al 1995 NDNS]

Nutritional issues in young children con’t… • A significant number of children under 5 are too heavy for their age and height • In 2007 about 30% Welsh children were either overweight or obese • Almost 16% of two year olds were overweight and 6% obese • Integrating physical activity and good food habits at an early age may be important for early obesity prevention (Reilly 2008)

Predicted to rise to 66% by 2050 Prevalence of obesity in the UK: CHILDREN • Toddlers (3 years): • 23.7% overweight or obese • Children (2-10 years): • 31% overweight or obese • Children (11-15 years): • 35.1% overweight or obese Millennium Cohort Study, 2007 Health Survey for England, 2004 (including updated trends) Tackling Obesities: Future choices, Foresight, 2007 Predicted to rise to 66% by 2050

Benefits of eating well for young children • It’s a time of rapid growth and development • Helps to establish good food habits • Provides essential nutrients and encourages exploration and enjoyment of food • Helps maintain energy levels and concentration throughout the day • Helps prevent and fight infections • Along with physical activity helps to promote a healthy balance of energy ‘in’ and energy ‘out’

Key nutritional messages • Young children need 3 meals a day and 2-3 nutritious snacks in between • A varied diet should be offered from the 4 main food groups every day: Bread, other cereals and potatoes Fruit and vegetables Milk and dairy foods Meat, fish and alternatives (e.g. Eggs, peas, beans and lentils)

Nutritional messages con’t… Children need ‘me sized meals’ – appropriate for their age

Drinks for toddlers • Water is the ideal drink to quench thirst • Milk is a good drink, but it also a ‘food’ • From the age of 1, milk is a useful drink between meals with a snack and before going to bed. On average, a 1-2 yr old should not need more than 400ml milk as a drink per day; a 3-4yr old no more than 300ml milk per day • Water or diluted 100% fruit juice can be given with meals • Children should have 6-8 drinks a day (in a beaker or a cup)

Food to avoid • Whole or chopped nuts • Children with allergies or eczema, or a family history of allergies should talk to a health professional about peanuts • Savoury foods designed for adults • Artificially sweetened foods • Foods and drinks with artificial colours and the additive sodium benzoate (E211) • Shark, swordfish or Marlin • Other foods and drinks designed for adults • Sweetened fizzy drinks and squashes

Early Years evidence tell us? What does the Early Years evidence tell us? Evidence Benefits • Mostly observational studies • Mostly in pre-school children • More physical activity is better • No clear evidence that it has to be of a particular intensity for benefits • Better for: • Social & emotional development • Physical development • Movement skills • Balance and coordination • Bone health • Body composition/fatness • Cardiovascular risk factors • Later physical activity adoption • Probably many other benefits

Rationale for the physical activity recommendations

Rationale – Prevalence of sedentary behaviour & screen time • Objective measures: pre-school children spend approx. 10-11 hrs/day in sedentary behaviour, TV at least 25% of this time • Subjective measures: 2 to 3 hrs/day watching television or other screen • Conclusion: apparently great scope for more physical activity during currently sedentary time

The secret life of pre-school children • Subjective measures suggest high levels of physical activity • Objective measures suggest much lower levels of physical activity • Absence of socio-economic differences in PA

GUIDELINES for EARLY YEARS (under 5s) 1. Physical activity should be encouraged from birth, particularly through floor-based play and water-based activities in safe environments. 2. Children of pre-school age who are capable of walking unaided should be physically active daily for at least 180 minutes (3 hours), spread throughout the day. 3. All under 5s should minimise the amount of time spent being sedentary (being restrained or sitting) for extended periods (except time spent sleeping). [Ref: Start Active, Stay Active - A Report on Physical Activity for Health from the four home countries’ Chief Medical Officers (July 2011)]   Report, Fact sheets and Guidelines available from www.bhfactive.org.uk

Background and Rationale • Need for practical support tools and training for early years practitioners identified as part of the Welsh Assembly Government’s 5 year implementation plan within ‘Food and Fitness – Promoting Healthy Eating and Physical Activity for Children and Young People’, launched in 2006 • Resources needed to complement other local and national initiatives e.g. Change4Life Early Years resources, Language and Play, Numbers and Play and Designed to Smile

AIMS • To develop bi-lingual activity cards to encourage physical activity through active play in 1-3yr olds, in both early years settings and for parents to use at home • To develop bi-lingual activity cards for developing good food practices in 1-3yr olds, in both early years settings and for parents to use at home

Overview of the cards • 20 of each active play and food cards • 10 of each were piloted (November 2010) • Reviewed and revised materials to include: 16, A4 laminated active play and food cards Practitioners leaflet Downloadable parents/carer resources for both active play and food

Overview con’t… • Seasonal theme but some are generic • Bi-lingual and can be photocopied for parents/carers • To be used as a prompt for further discussion

A brief intervention using the cards How can we use the food and activity cards to support healthy lifestyle changes?

A brief interventions: A definition ‘Brief interventions involve opportunistic advice, discussion, negotiation or encouragement. The interventions typically last between 3-5 minutes’

What motivates change? If you are told what to do, there is a good chance that you will do the opposite!! Your beliefs are more influenced by what you hear yourself say than by what others say to you

Brief intervention approach Remember the 4 ‘”A’s” • Ask Raise the issue neutrally and non-judgementally. • Assess How is the parent/carer feeling about making a change? • Advise What does the parent/carer already know about the issue and what do they want to know? Use the cards to provide information • Arrange Discuss what the parent/carer want to do next and how you can support them. • FINALLY Follow up – what happens next?

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